Occupational therapy in the school setting

Occupational therapy
in the school setting
background
• According to Kentucky Administrative Regulations for Special
Education Programs (2008), related services means
transportation and such developmental, corrective, and other
supportive services required in assisting a child with disability to
benefit from special education. It includes speech-language
pathology and auditory services, psychological services, physical
therapy, occupational therapy, recreation including therapeutic
recreation, early identification and assessment of disabilities in
children, counseling services including rehabilitation counseling,
orientation and mobility services, and medical services for
diagnostic and evaluation purposes.
Basic principles
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Federal and state laws mandate that all students have available to them
a free and appropriate public education (FAPE) that includes special
education and related services.
The student’s school based therapy goals based on academic
achievement and functional performance should directly relate to and
support his/her academic program.
The educational needs of students with disabilities are best served in
the least restrictive environment (LRE) by using a variety of
instructional strategies, with emphasis on collaborative team models
that facilitate learning in the student’s educational settings.
The appropriateness and extent of therapy services must be related to
the academic achievement and functional needs rather than the medical
needs of the student with disabilities.
Occupational therapy must be provided when specified in a student’s
IEP or service plan.
What is school-based occupational therapy in
the educational environment?
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Occupational therapy provided in the educational setting must be
educationally relevant and necessary for the student to access and
progress in the Kentucky’s educational system.
The focus of IDEA (2004) for therapists in the schools requires that
therapy services be provided as required to allow a child with a
disability as defined by IDEA to benefit from special education
services.
School based therapists collaborate with educators to identify needs
of the student and assist in providing strategies on how to best
capitalize on abilities as well as minimize the impact of the disabilities
in the educational environment.
Some students have a medical or developmental diagnosis that does not
affect the student’s ability to learn, function, or profit from the
educational experience. The provision of this type of therapy is not the
responsibility of the school.
A general guideline is that the therapy must contribute to the
development and improvement of the students academic and functional
performance.
The role of school based occupational
therapists
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Train parents and school staff in activities and accommodations to be
implemented throughout the student’s day.
Observe and critically analyze student performance and responses that
prevent the student from benefitting from his/her educational
program.
Identify, select, and adapt special materials and equipment to enhance
the student’s benefit from his/her educational program.
Identify and optimize natural opportunities for embedding skills during
daily routines.
Collaborate and coordinate with teachers and families for needed
change in instructional strategies and learning environment.
Suggest accommodations, modifications, and problem solving to promote
student success.
Support academic outcomes (e.g., math, reading, writing) and nonacademic outcomes (e.g., social skills and self-help skills).
The role of school based occupational
therapists cont.
• Occupational therapy addresses:
Performance Skills:
Motor, process, and communication/interaction
Performance Patterns:
Habits, routines, and roles
Performance contexts:
Cultural, physical, and social
Activity demands
Student factors:
Body functions and structures
The role of school based occupational
therapy assistants
• The occupational therapy assistant (OTA) provides occupational
therapy services to assigned students solely under the direction
and supervision of an OT.
• The OTA may contribute to the evaluation process by gathering
data, administering structured tests, and reporting
observations.
• The OTA may NOT evaluate independently or initiate therapy
prior to the OT evaluation.
• The OTA may contribute information data regarding student
performance that may lead to the discontinuation of
intervention.
• The OT is ultimately responsible for ALL occupational therapy
services.
Qualifications of the occupational
therapist
 Educational requirements: Entry-level bachelors, masters or
doctoral degree in Occupational Therapy fro a regionally accredited
occupational therapy program as verified by the Accreditation
Council for Occupational Therapy Education (ACOTE).
 Licensure: The OT must pass the OT Registration examination and
hold a current, active Kentucky license to practice as issued by the
Kentucky Board of Licensure for Occupational Therapy. This must
be renewed annually, before October 31, with payment for renewal
fee and evidence of the required 12 continuing competency units.
 Legally, no one except and OT or OTA can claim to be an OT or OTA
delivering occupational therapy services, however, educational staff
members may implement therapeutic activities based on the
recommendations and instruction of the OT or OTA.
The process
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Research based interventions
Referral
Evaluation
Eligibility
Individualized Education Plan
Service Delivery
Annual Review/Re-Evaluation
Research-based interventions
• A requirement of the IDEA 2004 is that school districts use
early intervening services or a problem-solving process for all
school-aged children as part of or prior to the referral and
evaluation process.
• Related service personnel are usually not direct members of this
process, however, they may be contacted for recommendations.
Therapists may then become involved in a problem solving
process that includes screening, developing interventions, data
collection, and decision making.
• OTs may provide teachers with strategies for making simple
changes in the classroom environment that will result in an
increase in student achievement.
referral
• If a child has not made adequate progress after an appropriate
amount of time of the research based interventions being
implemented, a referral for evaluation to determine if the child
needs special education and related services will be considered.
• An OT evaluation can be requested at the time of initial referral
if the ARC believes the information is necessary.
• OT evaluations may also be requested once a child is receiving
special education services if the ARC requests additional
information to implement the IEP.
evaluation
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Upon completion of the evaluation, a written report is completed and
delivered to appropriate individuals based on district procedure
timelines.
Educator and parents find it helpful to have OT evaluations and findings
reported in layperson terms. Medical terms should be explained by
definition or by application to the educational setting.
Outside assessments, recommendations, and/or orders from medical
facilities or private practices must be reviewed and considered by the
ARC; however, because they were completed in a clinical setting, the
relevance of the results to student performance in the educational
environment needs to be determined. It is the responsibility of the OT
to interpret the results of outside assessments and their relationship
to the student’s ability to access and participate in general education
curriculum.
Evaluation cont.
• Initial step in the OT evaluation is to obtain an occupational
profile. This profile provides an understanding of the student’s
occupational history and experiences, patterns of daily living,
interest values and needs.
• Concerns of the student, teachers, parents, or other involved
persons are identified and priorities are determined.
• An analysis of occupational performance follows the profile.
Student strengths and limitations are more specifically
identified.
• Performance skills, performance patterns, contexts, activity
demands, and student factors are all considered, but only
relevant selected aspects may be specifically assessed.
Common school relevant occupational
therapy evaluations
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Batelle Developmental Inventory (2nd ed.) (BDI-2)
Bruininks Oseretsky Test of Motor Proficiency (2nd ed.) (BOT2)
Miller Assessment of Preschoolers (MAP)
Miller Fun & Participation Scales (M-FUN)
Peabody Developmental Motor Scales (2nd ed.)(PDMS-2)
School Function Assessment (SFA)
Print Tool
Sensory Processing Measure (SPM)
Sensory Processing Measure Preschool Version (SPMp)
Sensory Profile School Companion
Developmental Test of Visual Perception (2nd ed.) (DTVP-2)
Eligibility
• The question that requires an answer is NOT “is the student
eligible for related services?” but rather, “is an OT’s knowledge
and expertise a necessary component of the student’s
educational program in order for him/her to achieve identified
outcomes?”
• All related services are available to students who qualify for
special education services if and when the related service is
shown to be necessary to implement the IEP. Therefore, results
of and OT evaluation or evidence of a delay or impairment does
not necessarily mandate services.
• In Kentucky, OTs do not need a referral from a physician to
provide services that are outlined on a student’s IEP. The ARC
determines the educational and functional need for OT.
Iep
• The IEP must state measurable annual goals for the student.
Goals focus on bridging the gap from where the student is to
where the student needs to be relative to identified KCAS
(Kentucky Core Academic Standards) academic skills and the
appropriate functional skills.
• OTs must be included in the development of an IEP for a child
that is eligible for OT as a related service. OTs often
contribute to the present level of function, annual goals,
benchmarks/objectives, specially designed instruction,
supplemental aids and services, and program modification to
meet the goals of the IEP.
Service delivery
• Decisions about the NEED for OT are guided by federal law and
state regulations.
• Decisions about HOW OT will be delivered are based on the
child’s needs, the expected outcomes, and the educational
program.
• IDEA defines that services may be provided directly to the
child, on behalf of the child, and as program modifications and
supports for school personnel. Services delivery is determined
by the child’s least restrictive environment.
• The frequency of related services should be specific enough to
accurately communicate to all team members how services will
be delivered, but should permit flexibility for integration of
services across a variety of educational settings and the child’s
school day.
Service delivery cont.
• Service delivery can be provided as role release or discipline
specific. Role release refers to systematic teaching and
learning across transitional discipline lines. Discipline specific
refers to services that are only addressed by licensed
personnel.
• There are decision making tools available to help determine
specially designed instruction, supplementary aids and services,
program modifications, and supports for school personnel.
Service delivery cont.
• OT services are provided in the student’s daily educational
routine. Therapeutic activities should occur throughout the
school day and routinely be implemented by educational
personnel after role release by the therapist.
• OT services are provided through a team approach. Team
members share information, strategies, and techniques to
assure continuity and generalization.
• OT services may vary over time. Student therapy needs may
differ in intensity and in focus during the student’s school years
and could differ in intensity within a school calendar.
Quality indicators of integrated
collaborative service model
• Block Scheduling
• Role Release
• Team Meetings
• Inclusive Educational Programming
Block scheduling
• Refers to large blocks of time created to teach one or more
areas of the curriculum with a group of students..
• This scheduling is planned in conjunction with other team
members and is flexible to allow team members to work
together on individual student’s programs when needed.
• The expectation is that planned interdisciplinary instruction will
enable service providers to provide appropriate services within
normal school routines rather than pull students out of class.
• Activities during block scheduled time may include: observing
and working directly with students, collaborating with teachers,
student or para-educator, providing support to primary
instructors, and documenting student progress monitoring.
Role release
• Role release involves team members providing information and
teaching intervention techniques to each other to promote
consistency in program implementation.
• Tasks traditionally performed by one discipline may be
delegated, under supervision, to other team members when
appropriate training has been provided.
• Levels of role release:
– General information: Communicating knowledge about basic
practices to other team members to increase understanding or
awareness.
– Specific Informational skills: Teaching others to make specific
judgments or decisions
– Performance competencies: Training other to perform specific
physical actions or procedures to implement programs with students
Team meetings
• Regularly scheduled meeting times that allows for ongoing
communication among team members.
• Can be used to review and revise students’ instructional
programs and for team problem solving.
• The agenda for these meetings is planned in advance, minutes
from the meetings are recorded and maintained, and notebooks
or message areas can be used so questions and concerns can be
addressed by team members when they visit/consult the
classroom.
Inclusive educational
programming
• Supports therapists focusing service delivery within
the classroom during daily routines to provide
opportunities for practice and development of skills
within the natural environments.
• Requires adaptations and special therapeutic
techniques to be utilized by the educational staff
throughout the day across many activities and
environments.
Summary of effective
therapy services
• Training parents and school staff in activities and
accommodations to be implemented throughout the student’s
day.
• Observing and critically analyzing student performance and
responses that prevent the student from benefiting from
his/her educational program.
• Identifying, selecting, and adapting special materials and
equipment
• Identifying and optimizing natural opportunities for embedding
skills during daily routines
• Collaborating and coordinating with teacher and families for
needed change in instruction and/or learning environment
Annual review/re-evaluation
• The ARC meets annually to review and revise the IEP.
Decisions are made at this regarding goals and
objectives, service delivery, transition, assistive
technology, re-evaluation, and continuation of related
services.
• Re-evaluations must be completed every three years.
• OTs are often a part of transition meetings including
school changes, graduation, early intervention, and
transfer students. It is beneficial for communication
to occur between the sending and receiving
therapists.
Assistive technology services
• KAR defines assistive technology (AT) as “any item,
piece of equipment, or product system, whether
acquired commercially off the shelf, modified, or
customized, that is used to increase, maintain, or
improve functional capacities of children with
disabilities.”
• Therapists may be involved with AT decisions through
evaluation, acquisition of AT devices, management of
AT devices, and training and coordination in the use
of the device.
Consideration for release
from OT services
• At the annual review, the ARC, based on data, may determine OT
services are no longer required and should be discontinued from
the student’s IEP.
• Appropriate reasons to release a student from OT:
– Student has met all of the functional OT objectives on his/her IEP
– The parent revokes consent for services
– The student no longer requires OT in order to access/participate in the
general curriculum
– Rate of skill acquisition, potential for progress, and/or level of function are
not likely to change with therapy intervention
– The student has learned appropriate strategies to compensate for his/her
disability
– Student’s needs can be managed through classroom
accommodations/modifications
– Student’s needs can be managed effectively by another service provider